• Brief history of health care and how things are in the process of change
• R.Ulrich Theories and findings: nature and healing.
• Wythenshawe hospital Manchester interview, Patient communication and privacy

2. Case study 1: Maggie’s cancer care facilities

• Do they address the above issues?
• Maggie’s goals and philosophies
• Current examples of the centres’ Architecture, do these building work well to achieve their ideals?
• Interview with a patient at Maggie’s, Christie’s hospital in Manchester
• Looking into the future

It was when I was taken ill in Thailand that I had my first hospital experience outside of the UK and I found myself feeling very restricted. At first, I was unable to physically move for several days even though I felt well enough to do so. The staff prohibited me from leaving my bed and room. I had very limited communication with people; I had no family around, my traveling companions were not with me and most of the people in the hospital didn’t speak English. It is general practice in Bangkok Hospital in Phuket that everyone had their own room, so I found myself isolated from other people for many days. These aspects of my experience were what I found most stressful overall but my confinement allowed me to appreciate my surroundings in a more critical way. Although the interior design of the hospital, which includes the fixtures, fittings and colour scheme, were intended to be calming and soothing, the isolation became an increasingly negative aspect of the experience due to the architectural structure of the space. The scale of the rooms, I believe was too large for one individual patient, which created a feeling of alienation and anxiety. It is this experience that has motivated me to look further into health care and to consider what is currently being done with the interior environment to promote the wellbeing of the patients.

Our Interior environment plays a significant part in our lives, surrounding us everyday. It shields us with an array of shape, colour, form and light. It is the first thing that we see when we wake up in the morning, the last thing we see at night and where we spend most of our day, it is bound to have a large impact on our psyches and emotions. The human psyche, being affected by the world around us, can be placed under a great amount of stress. As a result of this there is an impact of stress upon the body, which can manifest itself as illness and disease. The human mind is a powerful tool, which has the power to both heal and destroy our bodies. Many things have an impact on our well being such as the hormones in our body as well as the way we treat the body through food and exercise. However, the outside environment has become increasingly influential on the way we feel. Light, sound, comfort, warmth are all huge parts of our surroundings of which can have an impact on our mental wellbeing.
In hospitals, there is a significant level of mental stress due to the vulnerability of patients as well as their family members. Currently, there also exist many environment-based issues within hospitals that can affect or emphasise a person’s mental stress levels.
‘In the context of healthcare there will be nervousness and there will be fear. Inevitable to purpose space in a hospital we deal with anxiety and we deal with fear.’ This will need to be taken into account when designing these specific spaces. But how can these emotions be appropriately addressed through the atmosphere? In Dr Ulrich’s research in 1991- 2001 he found that ‘little attention was given to creating environments that would calm patients or otherwise address emotional needs’
He says that some hospital experiences are ‘traumatising’ and that ‘little emphasis has been given to creating surroundings that calm patients’
I wish to discover if this statement is true and whether there is anything being done to address these emotional needs, either in the UK or elsewhere and if so what is being done is effective enough to carry us into the future?
My objective is to conclude what it is in our sensory environment that can have an impact on our physical and mental wellbeing. I want to discover if environments in hospitals have, and are beginning to change for the better with healing and happiness in mind.
To help with my findings I have taken on case studies, I will firstly be looking into the objectives of the public sector of hospitals in the UK and how I believe they have been changing over the years.
The second is Maggie’s Cancer Care Centres. This is an organisation that I feel will be beneficial to me as their focus and philosophy is to adopt a unique and beneficial way of approaching health care through architecture. Maggie’s centres offer something to their patients that many other health care facilities do not. They focus on ‘risk taking, Aesthetic and spiritual with their commitment to the arts, including landscape.’ I am intrigued to find out more about the innovative, forward-thinking centres and understand whether their aims are successful.

Secondly, I will be looking at the interactive woodland for children at the Royal London Hospital, which uses interesting tools to help young patients to move and heal. They aim to promote healing through movement and imagination; I will be looking further into what they are trying to do. In the first section, I will focus on what’s being done in the UK, both in private and public facilities.

In the second chapter I will discuss the health care approaches outside of the United Kingdom and how they compare. I want to find out more about how Sweden, Norway and Canada are beginning to introduce more holistic, humanitarian methods to help patients to heal and why they are doing so. I hope to understand whether there is something that we can learn in the United Kingdom from the attitudes of these places in order to help us in the future.

Chapter 1: Health Care in the United Kingdom

My experience in Thailand is very similar to what was happening in the industrial era in the UK; ‘Medicine realised that germs cause illness and pollution can trigger disease in immune supressed patient. The sick were separated from the healthy. Buildings became more compartmentalized and hermetically sealed, private space became more important than public space.’ This struggle to stop infection from spreading caused health care to only isolate sick patients in a drastic way, which could possibly only assist to the growth of their individual illness rather than the recovery. In 1995, interaction was shown to unexpectedly heal a child when two premature twins were born. When one twin was struggling for her life, nurses placed the stronger twin together with her dying sister. At the time this was against hospital rules. However, this one move saved the baby’s life as almost immediately she began to stabilize with the blood and oxygen levels returning to normal. Although, confinement and restriction may have been thought to improve health through hygiene, it has been shown to be one of the main downfalls of healthcare, affecting the wellbeing of patients. This has begun to change in healthcare as the film I mentioned previously, ‘healthcare public space and the power of design’ goes on to explain; ‘Today the idea that patients should always be isolated is no longer the prevailing wisdom. Instead we find increasing emphasis on patient rights and family participation.’ Even Ulrich himself understands this when he says, ‘A growing awareness has developed in recent years of the health care community of the need to create functionally efficient and hygienic environments that also have pleasant stress reducing characteristics.’ By this, he means that there is no escaped the function requirements in hospitals that effect the atmosphere, however there are possibilities that are beginning to emerge that can help to reduce stress.
Furthermore, as well as consideration given to the interior architectural structure of the hospital, its interaction and utilisation of nature should be considered. Ulrich believes that nature and natural light has a profound impact on the healing of patients with the focus being on plants and gardens. He conducted a study of patients that all had undergone gallbladder surgery in 1972-1981, he chose forty six patient who had a view of a brick wall and twenty three whose window looked out on a view of nature. Whilst taking into account the age and medication taken by each patient he concluded that the people that looked out onto nature recovered a full day sooner than the patients who did not. When I spoke to a patient that had stayed in Wythenshawe hospital, they confirmed that they felt far more “healthy, grounded and at peace” on the days that they went into the hospital garden. They also went onto say that they found the electrical medical equipment “overpowering and distracting”. To understand more about what the atmosphere in public hospitals in the UK is like, I spoke to my father who has recently spent time in Wythenshawe hospital himself, and he told me that there seems to be more of an emphasis on having ward rooms with four to six people in. He thinks that there are advantages to this as he was able to form quite close bonds with other patients and nurses individually, which caused improved happiness through meaningful conversation and care for one another. He said that this contrasted from the way the wards were laid out twenty years ago with many people in one space, and the large amount of people and nurses actually caused him to feel more overwhelmed and lonely, without gaining any real relationships from the experience. He also mentioned that one of the things that kept him going on this small ward was being in close vicinity to a window that looked out onto a view of mountains in the distance which, again, backs up Ulrich’s theory that nature could help to heal. However he felt that the nature aspect was something that he has to seek out himself as there was little emphasis in his surroundings about nature but more drawn to the extensive amount of machinery. This gives me the impression as if there should be some sort of balance between the nature and the electrical equipment in order to draw the patients and families attention away from this to create a more calming ambiance with less unease.
He also drew my attention to the fact that he often he felt quite uncomfortable and often got up wanting to go for walks alone but was restricted and felt under constant observation, therefore I feel there could be more of a flexibility for the patient between observation, communication and patient privacy. It would be beneficial for the hospital to pay more attention to the design of the space in order to meet these emotional needs of the patients. I understand that that public hospitals that are owned by the NHS are currently facing many financial cuts, there may be many limitations for Wythenshawe hospital as well as many others all over the UK.

Maggie’s Cancer Care (Positive example of the UK, for now and in the future)
A good example of the way health care environments are being introduced is Maggie’s Cancer care facilities, which started in Scotland in the mid 1990s. These have become an architectural ‘miracle’ for many people. Recent centres have even gained the name ‘The Architecture of hope’. They aim to heal through the use of environmental nature in design. They feel as if they can ‘change society’ and the way we currently design for the purpose of healing. The Maggie’s centres are optimistic that the physical environment that they create can help patients to be ‘stimulated a challenged rather than depressed and overwhelmed’ They even go as far to say ‘We expect the physical space to do a significant amount of the work for us’ This goes to show that not only do they believe the physical surroundings can have a positive impact on the mind but they even rely on it to help improve they patients health. The architectural aims to benefit health are clear but the designs of each of the different centres vary. The centre at Inverness is a stunningly unique circular shape, shown in image 1. The ground floor is very ‘open and fluid’ with large curved doors, which allow the space to be subdivided; the subdivision and flexibility shows that they have addressed the issue I mentioned earlier of having a balance between private and public spaces for the patients. As you can see in image 2, the space is flooded with natural light. The top of the building is made with a green copper, apparently to resemble the sky and the trees, whereas the ‘copper at it’s base creates and grounding of brown to bond it more closely to the earth.’

I found the Fife building to be the most strikingly modern. No wonder it is said to go by all of the principles of the modernist era.
Contrasting with the subtle curving exterior of the Inverness centre, it has an unusually rigid envelope shape. The building itself looks as though it has been folded to look extremely triangular which sharp edges. It is very unique and unlike anything I could expect from a health care facility. However, ‘once inside, the dark, sharp, harsh planes give way’ and are replaced with, ‘subtly separated sensuously curving walls,’ Zaha says, ‘ You enter a completely different world. It’s kind of a domestic space. It’s relaxing. Hospitals should not be like machines; they should have intimate spaces, places where patients can have time for them to retreat into. Special experiences can elevate the spirits; it’s about how space can make you feel good.’ This again demonstrates the idea of having adaptable patient privacy as well as open public space. I can completely agree with the idea that the inside should make you feel comfortable and relaxed and that you should be able to retreat to have peaceful time in solitude. However, I am critical of the need to have such a massive contrast from the outside. Although it is an interesting and unique idea, from this image I find the dark colours and sharp edges quite intimidating and not what I would hope for from a relaxing health care facility. In some way they can even be related to the feeling one might get off the daunting electrical equipment I spoke about earlier. The dull concrete surrounding it is also a very harsh introduction to the centre; perhaps it could work better by incorporating some nature into the entrance and maybe reflecting the interior intentions on the outside as well.

In addition to architecture, Maggie’s centres give a structure of support to families with the overall objective to also to improve mental wellbeing. Overall, Maggie’s centres have five main principles: ‘Information, psychological support, living well, environment and design and milieu management.’ My question is, do they succeed in reaching all of these objectives and is all of this effective in helping the patients?

In a visit to Christie’s hospital in Manchester, I looked at the section that works in conjunction with Maggies. In an interview with a patient from the centre she told me that the main things that stood out for her were the themes, ‘The art are themes of fish and nature that are very successful in making a beautiful environment.’ She also said that, ‘The glass corridor is especially nice as it has a lovely garden you can see as you are walking through and also a conservatory.’ She also mentioned not only about the design of the space but she also felt very supported and relaxed when getting her treatment. ‘Beautiful music is played during the treatments, they aim to heal people, and they do this in a very caring and professional way.’ In the interview she also put emphasis on the fact that they strive to reassure patients that there is hope and plenty of research being done however there also people to make them feel more comfortable with their diagnoses through counselling on a regular basis. She said that she found this very useful and overall has a positive experience in her visits. This interview may not show all of Maggie’s Centres’ principles however it does display that not only is this centre successful in reaching all of their goals, they seem to also achieving effective positive results within the patients. I only hope that in the future these design principles conducted by the centres can be introduced to every hospital and health care facility around the UK, as the benefits are clear it should be accessible to the whole population.

Children’s interactive hospital in London

Movement and interaction are thought to be techniques that can be introduced through design that could help patients to heal. Royal London’s hospital has created an interesting environment for children enabling them to physically play and move. The room is a giant installation made by Chris Oshea. It involves an interactive creative game on a giant television the size of a room, the idea is that it ‘allows children to enter into a storybook illustrated world enabling them to: paint; play music and trigger sun, rain, snow and rainbows weather effects with animated animal characters across a number of woodland scenes.’ He also says the idea helps the children ‘benefit from the healing powers of art’ Interestingly, the ideas behind this game allow the patients to become creative and interact with nature; both of these things have been know to help the healing process. For example the organisation ‘start2’ are a company that also focus on creativity in the healing process. They travel around the UK trying to encourage people to adopt a creative hobby in order to improve their wellbeing and health, I myself went to one of the sessions and afterwards I feel extremely relaxed and at peace as well as stimulated and inspired. I was told in personal communication with the teacher, during the creative wellbeing workshop that when you are engaged in creative activity your heart rate slows down and you blood pressure begins to drop to a healthier level.

As well as stimulating the children physically, Oshea’s installation aims to stimulate the children’s minds and imaginations. He goes onto explain that the child’s real life image is reflected in the game in order to bring the “unimaginable to life” he say this helps in “allowing them to escape the reality of their daily treatment and interact with the exciting animated environment” In my opinion I think that this is wonderful approach, as strengthening their imagination and encouraging this positive outlook that perhaps ‘anything could happen’ could ultimately lead them to better health.
Oshea also mentions that he has to take into account when designing for the children that there maybe very sick patients as well as patients in wheelchairs so the

I find this idea of interactively and creatively stimulating the children in hopes to improve their healing ground breaking. However, I feel that it is limited in the fact that not much is being done to give this same opportunity to adults as well. The creative process and imagination should not just be limited to children, I think that that can only lead to adults perhaps supressing these qualities within themselves and believe that it is not possible to have these. If the negative thought process that leads to depression and anxiety has the possibility to be broken by imagination then this should be shown to both adults and children alike, especially those in a vulnerable state. No matter what age we are, we all share common emotions especially when we are in a vulnerable state due to physical or emotional illness.

Chapter 2 Approaches outside of the United Kingdom

Sweden: Artistic enhancement for a calmed patient response
In Sweden, it has become important to incorporate creativity and the artistic process into architecture and buildings. It is in Sweden that they have decided to earmark one percent of building costs to put towards artistic enhancement for all buildings. Not only is this similar to Maggie’s and to the goals of the London Royal Hospital children’s section, they believe that it’s a vital part of the healing process.
Swedish/Issaquah medical center promote by using healing through art, they believe that hanging relaxing art, much like they do at the Maggie’s section in Christies hospital, helps to heal the patients. “When patients become absorbed in a work of art, their bodies’ physiology actually changes, moving from sensations of stress and fear to feelings of relaxation and hope,” Joyce Turner states. “It humanizes what could be a dehumanizing environment.” I believe they have taken into account the ‘dehumanizing’ negative emotions that are present and can be invoked in this specific environment and they are addressing this through the means of artwork.
Additionally, in a study for Swedish hospitals there was a project formed together with the University College for Arts, Craft and Design in Stockholm. Students worked using the subject matter, ‘How does it feel – how do we make it feel better?’;
‘ They held seminars on health care design, visited other wards and interviewed staff and parents on positive and negative aspects of the ward setting, especially on the effects of interior design, coloring, technical appliances etc.’
They also decided to incorporate Nature, which seems to be a recurring theme when it comes to relaxation and diminishing the inevitable anxiety. They believed that it would have a soothing effect in opposition to the technical side of things. However does this artistic Scandinavian approach to design in healthcare work? Nick Triggle says, ‘Cancer survival rates, infant mortality and life expectancy figures all outstrip many of its European neighbors.’ This may indicate that their approaches attributed to the better health of the Scandinavian population.

Norway: Holistic approach creating Normality and a natural habitat for patients and families

St Olav’s University hospital in Norway, another Scandinavian country, has conducted a study that aims to improve the wellbeing from the patients’ perspective. It’s their belief that they should address ethical and aesthetic issues: how physical surroundings reflect a perspective on humanity. They have designed and built the hospital specifically to address the humanitarian issues and it is designed so that it can blend in with the surrounding landscape as well as the neighborhood. The idea is to make it an approachable and accessible everyday space no different to any other, to reduce the levels of worry and anticipation. It is an open structure, which would allow light and people to flow freely and naturally. Ragnhild Aslaksen, the chief architect of the hospital states, ‘The urban block structure separates out-door space into center-private gardens and public streets and parks. The public space opens and connects the hospital to surrounding landscape and neighborhood.’
This has proven to be an extremely successful way to take the functional requirements of the facility, which may prove to have a negative effect on the psyches of people and balancing it with a more positive environment for them.
‘The urban block structure has demonstrated great flexibility to adapt changes in organization and building program, without compromising the basic architectural and functional qualities. The organization of a center is not fixed to a specific
block, but can be divided between different blocks according to actual patient and staff logistics. The idea of a fixed pattern for future hospital buildings also allows for wide architectural variations within the hospital plan, without creating a situation that often occur in hospitals, chaotic and contradicting physical environments.’
This tells me that they are thinking about more positive, health care facilities for the future, they are adopting the idea of diminishing the more chaotic spaces in order to improve the feelings within these environments with this strategy.
Another theme that the hospital has taken upon themselves is again the idea of nature and that incorporating it into the surrounding is important to the health of the patients.
There was already nature surrounding the site that the hospital was then connected to as you can see in figure 5.

(Image 5) Art and nature; illuminated stones at the entrance boulevard,
Established before the first centers were constructed.

Aslaksen continues to write, ‘The healing effect of visual and physical contact with nature is proven both through science and experience. The Hospital Project has placed great emphasis on adapting elements of nature and living life into the various levels of the hospital design.’ She always incorporates nature continuously throughout the entire space as a fundamental part of the design. There are gardens on every block, it’s planned so every patient has a view of the gardens from their beds, this is very beneficial to the healing process as proven in the study mentioned earlier by Ulrich. She says that they place emphasis on nature and ‘living life’, I find this extremely interesting as I believe nature is an essential part of living as we are part of nature, our whole living being is a part of nature much like the trees and animals that thrive in the wild. As we have very little time in the modern society to spend in our natural habitat, perhaps this is the reason that nature is so effective when it comes to the healing process. It could be bringing these people ‘back to life’ by introducing them into their real and natural place in the world.
The space also takes advantage of nearby nature environments and elements such as the fishing river and it uses natural material on the interior and exterior of the building. The hospital continues to work towards the wellbeing of the patients by following Scandinavian principles of staff participation in the design process but also incorporating the participation and emotional needs of the patients and families. The process involved patient participation greatly in order to realize the layout and needs of the patient. Image 6 shows the interaction and separation between the main groups in the hospital, it was realized that the patients and families have specific design needs separate from the technical and clinical operations.

(Image 6) interaction and separation between the main groups

Aslaksen writes, ‘Contribution from environmental psychologists has outlined that the potential for mutual contact between groups and individuals, is affected by the possibilities for setting relevant boundaries. The solution also creates opportunities for designing the architectural surroundings to better suit the patient while improving patient and staff contact.’ They are striving to understand the physiological needs of the patients by considering that the patient should have the choice between having more private spaces as well as public and approachable space. This links back to the Maggie’s Cancer care facilities, where they aim to have spaces that are open and fluid in some places as well as having more private spaces where a patient can choose to be alone, thus giving them more of a choice to move and behave naturally in the space, also giving them an added feeling of ‘normality’ and ease.

As it was a positive way to improve wellbeing, the patient involvement of the development of the scheme, created a debate in Norway about the idea of more holistic approaches. ‘One result is the idea of a holistic resource model for hospital development as a tool for developing a hospital from the patient perspective.’
You can see in Image 7 the ideas behind this holistic healthcare system.

(Image 7) Holistic Model, human and material resources

Canada

Canada, has similar principles to the Scandinavian countries, it is beginning to follow the same regimes and incorporate separation of the hospital sectors. For example, in staff areas, technology, visiting areas and patient wards. They also give a lot of focus and attention to the emotional needs of the patients, staff and visitors. Eberhard Zeidler, partner in charge of design in Toronto believes that a lot is being done about the functional and economical requirements of hospitals all over the world but the emotional needs has been greatly neglected. He speaks in the same article about his belief in Ulrich’s theories about nature and healing and talks about the proof of that in is study of nature outside the patient’s windows as mentioned earlier. He says that we need to pay more attention to, ‘emotional needs of its patients and also its staff as well as its visitors who are involved in the healing process.’ Moreover he stresses great importance in Canada of the separate sectors as it keeps the atmosphere safe, calming and that the public waiting space, connections as well as the more private ward spaces must be extremely pleasant places to be. ‘A pleasing atmosphere that guides you to your destination in a relaxing way, that offers you places to sit down and wait, to create pleasant connections.’ Image 8, 9, 10 and 11 are all photographs of waiting areas and connections in Canadian health care facilities. What I immediately notice from photographs is again the incorporation and greenery and nature, as you can see there are multiple examples of this in Canada as a method of helping release stress. In comparison to Image 12 of Wythenshaw Hospital in Manchester United Kingdom, you can see there is far less natural light, space and greenery therefore making the space seem far less organic. The natural environments of the Canadian hospitals I predict would encourage growth and change in an intuitive way as a result of witnessing the growth of the living plants. In addition I expect that it would ignite healthy clean oxygen flow, which would, in turn, encourage the healing process.

Conclusion
To conclude, let us think back to my original point about Ulrich’s theories and experiments. He believed that there was a negative hospital experienced stimulated in the patients and families in that environment. He says that the average hospital experience was drab, depressing and isolated due to the physical surroundings.
Although you can’t escape the visually unsettling attributes that come with healthcare requirements such as machinery and electrical equipment, it is important to find a balance so that it’s possible for patients to remain in a socially interactive and calming environment that can possibly incorporate nature and lots of natural light.
My studies in both Canada and Scandinavia suggest that there must be a clear separation between the functions of the hospital in order to keep the atmospheres pleasant and safe for the patients and families as well as the staff.
Canada places importance on creating calming and non-hectic and clear public spaces in order for visitors and patients to get where they need to be easily and peacefully. In addition to this, from the patient’s point of view having a variety of private and public rooms for the needs of their wellbeing is essential. It may be critical to keep the hygiene satisfactory in order to reduce the spread of infection to diminish constant isolation. It’s apparent that Norway’s more holistic approach to health care finds great importance in taking care of the physiological needs of the patients, they understand that patient participation in the design process can lead them to new idea’s that benefit the patient’s satisfaction and wellbeing. By encouraging a feeling of normality and natural habitat for the patients and families they are successful in creating a feeling of ease rather than anxiety. In Sweden they also place great importance on the well being of their patients and believe that by the use of art, they can help to diminish stress and aid the healing process. Both Scandinavian countries are successful in cultivating the wellbeing and restoration of their patients through creating environments with the incorporation of art, nature and relentless patient involvement during the design process.
Maggie’s is one of the UK’s positive examples of everything that is right with health care, they succeed in helping patients in gaining healthy wellbeing and hope for the future. They give support and guidance to families and patients and create stunningly beautiful and comfortable environments for the patients. Its only downfall could be the experimental nature of the building may not always work as it is a relatively new concept, which is still learning and growing; however, they have only positive aims for the future of their health care. Maggie’s have also introduced the positive structural principle of incorporating flexible public and private space which allows patient’s the choice to seek solitude when needed as well as separating the more stress inducing technical environments. From London’s Royal Hospital I gain the understanding that it is the interaction with nature and art that helps to gain the positive results by incorporating movement, activity and a sense of fun, these are beneficial when giving children some hope and create positive emotions through imagination and creativity.
I have learnt, through my own experience in Thailand and my studies that it’s important in order to effectively promote healthy wellbeing in patients and families, designers need to consider not only the overall exterior architectural design of hospitals but, more importantly they must pay consideration to the internal structure through: the use of subdivisions of sectors, public and private space; natural flowing openness of the building, utilization of nature to conceivably invoke feelings of life and growth; connectedness to outside space; art and creative imagination with possible feelings of hope and contentment; and connecting it with the outside context of the hospital in order to encourage the feeling of normality to help ease fearful anticipation. It would be most beneficial for these attributes to work together in harmony in order to receive the best results.
It is apparent that the UK are beginning to introduce some of these principles into the health care system through Maggie’s Cancer care facilities and London’s Royal Hospital. However I believe that they could benefit greatly from having more sensitivity to the patient and families’ emotional needs in all hospitals for both adults and children. Evidently from the example of Wythenshaw hospital, there are still many health care facilities that could be improved through devotion to the wellbeing of the patients and visitors.

(Image 5)
Unknown Photographer, Art and nature; illuminated stones at the entrance boulevard, Established before the first centers were constructed. Design and health ‘From Visions To Plans And Physical Environments; Designing Hospitals From A Patient Perspective’, WCDH [Online] http://www.designandhealth.com/

(Image 6)
Urban Block, interaction and separation between the main groups, design and health ‘From Visions To Plans And Physical Environments; Designing Hospitals From A Patient Perspective’, WCDH [Online] http://www.designandhealth.com/